Billing and Coding: MolDX: Breast Cancer Assay: Prosigna®

This billing/coding guideline specifies how to report the Prosigna® breast cancer assay: submit CPT 81520 with 1 unit of service and include the appropriate ICD-10-CM diagnosis. The DEX Z‑Code identifier must be reported adjacent to the CPT code in the specified electronic or paper claim fields for Part A and Part B, and clinical coverage is governed by MolDX LCD L36125.

"Prosigna® (breast cancer) assay claims must meet the clinical coverage criteria specified in the MolDX Local Coverage Determination L36125."

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